Feb. 15--Whether through losing weight or losing money, Cumberland County employees will soon be tightening their belts.

Starting next year, the county will require employees to meet health-improvement targets to earn a discounted rate on their insurance. The county's insurer recommended the move as a way to keep costs down, and leaders are backing it.

Employees were notified Jan. 23. Some are calling the plans Draconian and humiliating.

"We're trying to do what we can do to contain costs," County Manager James Martin said. "Employee accountability is one way to try to do that."

The county spent $17.6 million on its employee health plan in the 2011-12 fiscal year. Claims were up 11 percent over the year before. High blood pressure, heart disease and diabetes were the top three claim areas among employees and dependents covered by the plan.

For several years, employees have received a $30 discount on monthly premiums if they attend an annual wellness fair. Employees are weighed and have their blood pressure, cholesterol and glucose levels checked. At next month's fair, employees also will have their waists measured. That will set a baseline for future measurements.

"What we're looking for a year from now is that there's an improvement in those," Martin said. "If you're already healthy, then fine, but just maintain that."

Participating employees must meet established standards in three of the four areas -- such as a 40-inch waist for men, 35 for women, blood pressure of 140/90 or lower -- or show 10 percent improvement to qualify for the discount. Employees who do not participate will not get the discount.

Some are crying foul, calling the new requirements intrusive and unfair. Some worry the health information will be a factor in promotions. Employees who were interviewed for this story did not want to have their names published for fear of reprisals.

A growing number of local governments are using similar strategies. The Fayetteville Public Works Commission gives employees a credit for maintaining a body mass index below 40. Cleveland County is among the other counties recording employee progress in healthy living.

"We've had lots of complaints," said Dorothea Wyant, Cleveland County health director.

The county took baseline measurements last year, and employees will be screened again in April. Wyant said county leaders have not decided what the penalty will be for employees who fail to meet their improvement targets.

"It could be the county may choose not to do anything," she said.

Dr. Deborah Peel, founder of the national Coalition for Patient Privacy, said such policies amount to coercion.

"To keep your privacy, you have to pay," she said. "I don't know about the legality of that."

Peel said counties cannot guarantee the health information they collect is safe from hackers.

"They really can't do state-of-the-art security," she said. "Health information is very valuable."

Cumberland County opened a primary care clinic and pharmacy in the old Health Department in 2012, both to keep county costs down and to promote healthy living. Employees are allowed an extra 30 minutes for lunch if they spend it exercising.

A trio of county workers spend one lunch break each week walking the mile across downtown to the employee health services building for a weekly seminar in the county's eight-week Eat Smart, Move More, Weigh Less series.

"I don't have a problem with it at all," said the group's Fred Starling as he strolled along Russell Street. "I don't see a downside to it."

Martin acknowledged there has been "a little pushback" from some employees.

"As unpopular and distasteful as it is, that's what we need to do," he said. "Otherwise, the cost of employee health care is going to go so high that we're going to end up in a situation where employees are going to have to pick up a greater and greater share of the cost of their individual health insurance."

Martin said he has been working on his own health, walking for 45 minutes before work.

Jimmy Keefe, chairman of the county Board of Commissioners, said he's lost 15 pounds through diet and exercise.

"Over and above everything to do with the financial part of it," Keefe said, "it's just good for all of us."